Reliability of social and personal competence measures for adolescents

Onset of the Non-Medical Use of Prescription and Over-the-Counter Medications during Early Adolescence: Comparison with Alcohol, Tobacco, and Marijuana

This study examined the prevalence and psychosocial predictors of the non-medical use of prescription and over-the-counter (OTC) medications and compared these to cigarette, marijuana, and alcohol use in a cohort of early adolescents (N = 1887) aged 11 to 13, a critical risk period for the initiation of substance use. Participants were students attending 22 middle schools in the northeastern United States. Participants completed surveys in the classroom, the first in the sixth grade and a second in the seventh grade, and the rate of overall substance use more than doubled from 5.5% to 11.9% over this period. Predictors of the onset of non-medical prescription and over-the-counter drug misuse overlapped substantially with those for marijuana and other substances. The perception of friends' substance use and the belief that substance use can help you deal with problems predicted the onset of marijuana use, OTC medication misuse, and prescription drug misuse. Decision-making skills were protective for the onset of all substance use outcomes. The findings of this study have important implications for prevention and suggest that a single comprehensive approach may be sufficient for preventing multiple forms of substance use onset during early adolescence.

Study protocol of the Our Futures Vaping Trial: a cluster randomised controlled trial of a school-based eHealth intervention to prevent e-cigarette use among adolescents

BACKGROUND

Effective and scalable prevention approaches are urgently needed to address the rapidly increasing rates of e-cigarette use among adolescents. School-based eHealth interventions can be an efficient, effective, and economical approach, yet there are none targeting e-cigarettes within Australia. This paper describes the protocol of the OurFutures Vaping Trial which aims to evaluate the efficacy and cost-effectiveness of the first school-based eHealth intervention targeting e-cigarettes in Australia.

METHODS

A two-arm cluster randomised controlled trial will be conducted among Year 7 and 8 students (aged 12-14 years) in 42 secondary schools across New South Wales, Western Australia and Queensland, Australia. Using stratified block randomisation, schools will be assigned to either the OurFutures Vaping Program intervention group or an active control group (health education as usual). The intervention consists of four web-based cartoon lessons and accompanying activities delivered during health education over a four-week period. Whilst primarily focused on e-cigarette use, the program simultaneously addresses tobacco cigarette use. Students will complete online self-report surveys at baseline, post-intervention, 6-, 12-, 24-, and 36-months after baseline. The primary outcome is the uptake of e-cigarette use at 12-month follow-up. Secondary outcomes include the uptake of tobacco smoking, frequency/quantity of e-cigarettes use and tobacco smoking, intentions to use e-cigarettes/tobacco cigarettes, knowledge about e-cigarettes/tobacco cigarettes, motives and attitudes relating to e-cigarettes, self-efficacy to resist peer pressure and refuse e-cigarettes, mental health, quality of life, and resource utilisation. Generalized mixed effects regression will investigate whether receiving the intervention reduces the likelihood of primary and secondary outcomes. Cost-effectiveness and the effect on primary and secondary outcomes will also be examined over the longer-term.

DISCUSSION

If effective, the intervention will be readily accessible to schools via the OurFutures platform and has the potential to make substantial health and economic impact. Without such intervention, young Australians will be the first generation to use nicotine at higher rates than previous generations, thereby undoing decades of effective tobacco control.

TRIAL REGISTRATION

The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12623000022662; date registered: 10/01/2023).

Effectiveness of a hybrid digital substance abuse prevention approach combining e-Learning and in-person class sessions

Background

Effective school-based programs for preventing substance abuse offer considerable public health potential. Yet limited class time and uneven implementation fidelity can be barriers to widespread adoption and high-quality implementation. A hybrid digital approach may be effective and help address these barriers.

Objective

To evaluate the effectiveness of a hybrid substance abuse prevention program for middle school students consisting of e-learning modules and in-person class sessions.

Design

Twenty-three United States (U.S.) middle schools were randomly assigned either to an intervention condition (13 schools) or a treatment-as-usual control condition (10 schools) where standard health education material was delivered. There were 1,447 participants who completed the pre-test and post-test assessments, of which 48.3% were male and 51.7% female.

Intervention

The hybrid digital intervention consisted of 14 brief e-learning modules and six classroom sessions adapted from an evidence-based program designed for classroom implementation to increase knowledge of adverse consequences of substance use and improve social skills, personal coping skills, and skills for resisting social influences to smoke, drink, or use drugs.

Measures

Participating students completed online pre-test and post-test surveys to assess substance use, knowledge, and life skills.

Results

There were significant reductions in substance use for the hybrid digital condition compared to the control condition as well as significant increases in health knowledge, skills knowledge, and life skills.

Conclusions

A hybrid digital approach to substance abuse prevention is effective and offers potential for overcoming common barriers to widespread adoption and high-quality implementation.

Prevalence of and Factors Associated with Club Drug Use among Secondary Vocational Students in China

To understand the prevalence of and factors associated with club drug use among Chinese secondary vocational students, a nationally representative survey was conducted. The multistage cluster sampling strategy was employed to select participants. A total of 9469 students from eleven secondary vocational schools in five cities completed self-reported questionnaires, which included information on club drug use, sociodemographic variables, individual factors, as well as peer and family related factors. The data were separately analyzed with Poisson regression models for female and male students. The overall lifetime prevalence of club drug use was 2.7% (258/9469), and male students had higher prevalence than female students (3.5% vs. 1.9%, p < 0.001). Female and male students shared four risk factors (i.e., having ever smoked, perceiving social benefit expectancies, peer drug using and perceiving peer's approval of drug use) and one protective factor (i.e., having medium or high levels of refusal skills) for club drug use. Moreover, family drug using and having a part-time job were two additionally independent risk factors for club drug use among male students. These findings indicate that the problem of club drug use among Chinese secondary vocational students is worthy of attention. The prevention of club drug use should address multiple risks and protective factors on individual, peer and family levels.

Testing an evidence-based drug abuse and violence preventive approach adapted for youth in juvenile justice diversionary settings

BACKGROUND

Universal school-based prevention programs for alcohol, tobacco, and other drug use are typically designed for all students within a particular school setting. However, it is unclear whether such broad-based programs are effective for youth at risk for substance use and violence in juvenile justice settings.

METHOD

The present study tested the feasibility, appropriateness, and efficacy of a preventive intervention to reduce risk factors for substance use and delinquency among youth in juvenile justice diversionary settings by promoting positive youth development and building personal strengths and prosocial relationships. Participants in the study (N = 288) were predominantly male (69%) and in the 9th grade (14 years old) or higher (91%), received the preventive intervention, and completed confidential questionnaires at the pre-test and post-test.

RESULTS

The majority of youth who participated in the intervention rated the program topics (77.9%) and activities (72%) as appropriate for their age, would recommend it to their peers (73.6%), and would use the skills learned in the future (85.4%). Comparison of post-test adjusted means revealed that the prevention program had a significant positive impact on key knowledge, attitudes, and skills including goal-setting, stress-management, and communication skills.

CONCLUSIONS

The findings indicate that an evidence-based prevention approach adapted for youth diversionary settings can be effectively implemented and well-received by participating youth, and can produce positive changes in psychosocial skills and protective factors known to prevent multiple risk behaviors among youth. Future efforts to implement substance use prevention in community juvenile justice settings may benefit from highlighting a positive youth development, skills-based approach.

Two- and three-year follow-up from a gender-specific, web-based drug abuse prevention program for adolescent girls

INTRODUCTION

Rates of drug use among early adolescent girls meet or exceed rates of their male counterparts. Girls are also vulnerable to differential risk factors for drug use. Yet, expressly designed prevention programs targeting this population are absent. The present study reports 2- and 3-year findings on a web-based drug abuse prevention program for adolescent girls.

METHODS

A sample of adolescent girls (N = 788) were recruited via Facebook. Online, all girls completed pretests; girls were randomly assigned to a 9-session intervention arm or to a measurement-only control arm and all girls completed posttests. All girls also completed 1-, 2-, and 3-year follow-up measurements.

RESULTS

At 2-year follow-up and compared to girls in the control arm, intervention-arm girls reported less past-month cigarette, marijuana, and "other" drug use (club drugs, cocaine, ecstasy, hallucinogens, heroin, inhalants, methamphetamines, steroids, prescription drugs), lower rates of peer drug use, and increased scores on drug refusal skills, coping skills, self-esteem, media literacy, and self-efficacy. At 3-year follow-up, and compared to girls in the control arm, intervention-arm girls reported less past-month cigarette and e-cigarette use, lower rates of peer drug use, lower reported anxiety and stress, and increased scores on drug refusal skills, self-esteem, media literacy, self-efficacy, and body image.

CONCLUSIONS

Longitudinal outcome data lend support to the efficacy of a gender-specific, web-based drug abuse prevention program to reduce adolescent girls' drug use rates and associated risk factors.

Factors Affecting Secondhand Smoke Avoidance Behavior of Vietnamese Adolescents

The purpose of this study was to examine the stage of secondhand smoke avoidance behavior of adolescents in rural areas of Vietnam and the related factors affecting such behavior. The participants were recruited from two middle schools located in Hai Thuong and Trieu Trach commune, Vietnam. Data were collected in January 2016 by distributing and collecting a self-administrated questionnaire. The collected data were analyzed (n = 166) using SPSS 21.0 for frequency, percentage, and ordinal logistic regression. The largest proportion of secondhand smoke avoidance behavior was classified in maintenance (41.6%), followed by action (19.9%), preparation (15.1%), pre-contemplation (13.3%), and contemplation (10.2%) stages. The factors related to higher secondhand smoke avoidance behavior were higher self-efficacy (p = 0.003) and more frequent discussion with parents about dangers of smoking (p = 0.001). The findings indicated that self-efficacy of avoiding secondhand smoke and discussion with parents were associated with secondhand smoke avoidance behavior of adolescents. These findings can be used for developing education programs to prevent secondhand smoke for adolescents in Vietnam.

Preventing Adolescent Substance Use Through an Evidence-Based Program: Effects of the Italian Adaptation of Life Skills Training

Evidence-based preventive interventions for adolescent substance use, violence, and mental health issues are increasingly being adapted and disseminated internationally. In the present paper, we report the results of an effectiveness study that was part of a comprehensive initiative by a coalition of health promotion organizations in the Lombardy region of Italy to select, culturally adapt, implement, evaluate, and sustain an evidence-based drug abuse prevention program developed in the USA. Findings are presented from a large-scale effectiveness study of the Life Skills Training prevention program among over 3000 students attending 55 middle schools in Italy. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills. Relative to comparison group students, students who received the prevention program were less likely to initiate smoking at the post-test and 2-year follow-up, and less likely to initiate weekly drunkenness at the 1-year follow-up. The program had direct positive effects on several cognitive, attitudinal, and skill variables believed to play a protective role in adolescent substance use. The findings from this study show that a drug abuse prevention program originally designed for adolescents in the USA is effective in a sample of Italian youth when a rigorous and systematic approach to cultural adaptation is followed that incorporates the input of multiple stakeholders.

An Online Drug Abuse Prevention Program for Adolescent Girls: Posttest and 1-Year Outcomes

Early adolescent girls' rates of drug use have matched, and in some instances, surpassed boys' rates. Though girls and boys share risk factors for drug use, girls also have gender-specific risks. Tailored interventions to prevent girls' drug use are warranted. This study developed and tested a web-based, drug abuse prevention program for adolescent girls. The nationwide sample of 13- and 14-year-old girls (N = 788) was recruited via Facebook ads. Enrolled girls were randomly assigned to the intervention or control condition. All girls completed pretest measures online. Following pretest, intervention girls interacted with the 9-session, gender-specific prevention program online. The program aimed to reduce girls' drug use and associated risk factors by improving their cognitive and behavioral skills around such areas as coping with stress, managing mood, maintaining a healthy body image, and refusing drug use offers. Girls in both conditions again completed measures at posttest and 1-year follow-up. At posttest, and compared to girls in the control condition, girls who received the intervention smoked fewer cigarettes and reported higher self-esteem, goal setting, media literacy, and self-efficacy. At 1-year follow-up, and compared to girls in the control condition, girls who received the intervention reported engaging in less binge drinking and cigarette smoking; girls assigned to the intervention condition also had higher alcohol, cigarette, and marijuana refusal skills, coping skills, and media literacy and lower rates of peer drug use. This study's findings support the use of tailored, online drug abuse prevention programming for early adolescent girls.

Risk and protective factors associated with adolescent girls' substance use: Data from a nationwide Facebook sample

BACKGROUND

Despite overall reductions in teenage substance use, adolescent girls' rates of substance use remain unacceptably high. This article examines whether girls' substance use is associated with general risk and protective factors (goal setting, problem solving, refusal skills, peer use, and self-efficacy) and gender-specific risk and protective factors (communication style, coping skills, self-esteem, body image, perceived stress, anxiety, and depression).

METHODS

Cross-sectional data were collected in 2013 via online surveys from a nationwide sample of adolescent girls (N = 788), aged 13 and 14 years, who were recruited through Facebook.

RESULTS

In multivariate analyses, controlling for correlates of adolescent substance use, 11 of the 13 general and gender-specific risk and protective factors were consistently associated with past-month alcohol, cigarette, and other drug use in the expected direction; past-month marijuana use was associated with 8 of the 13 factors. Refusal skills, peer use, coping, and depressive mood were most consistently and strongly associated with substance use.

CONCLUSIONS

Substance abuse prevention programs targeting adolescent girls should focus on such general risk and protective factors as problem solving, refusal skills, peer influences, and self-efficacy, as well as such gender-specific risk and protective factors as communication style, coping, self-esteem, body image, perceived stress, and mood management.

Results of a 3-Year Study of Two Methods of Delivery of Life Skills Training

Model programs and standards for substance abuse prevention have been identified by a number of federal agencies. The study reported here assessed two methods of delivery of one such program, Life Skills Training (LST), implemented in nine rural disadvantaged school districts. The results indicate that neither standard LST nor an infused LST delivery method was found effective for the entire sample, although some encouraging results were foundforthe females in the study. This study, conductedbyresearchersindependentof the LST program, is useful for school decision makers in determining what programs are most effective with which groups. It includedall studentswith parentalpermission,controllingforprioruse levels, unlike some previous LST studies. The results of the program, as implemented by regular classroom teachers, reflect many issues relevant to recruitment, training, implementation, adaptation, and institutionalization of prevention programming.

Perceived friend and peer smoking and direct and indirect refusal skills as predictors of cigarette smoking in U.S. and Japanese middle school students

Adolescents (aged 12-14 years) from the United States (n = 539) and Japan (n = 644) completed surveys regarding tobacco use, perceptions of friend and peer smoking, and their own likelihood of using smoking refusal skills. U.S. youth were more likely to report lifetime or monthly tobacco use, whereas Japanese youth were more likely to smoke ≥20 cigarettes per week. High perceived friend and peer smoking prevalence predicted lifetime smoking, whereas direct refusal skill use (e.g., "saying no") predicted less lifetime tobacco use. Results are discussed in terms of cultural influences that may mediate the effect of risk factors on U.S. and Japanese youth.

Time-limited, structured youth mentoring and adolescent problem behaviors

Youth mentoring can have a profound impact on the lives of high-risk youth. This study presents the Campus Corps program, a time-limited (12-week), structured mentoring program for high-risk youth (ages 11-18), and results from a quasi-experimental pilot evaluation. Baseline and post-intervention problem behavior data from 315 offending youth were used in multiple regression analyses. After accounting for baseline group differences, pre-intervention scores, and demographic covariates, Campus Corps participants (n=187, 63.1% male) reported less engagement in problem behavior, lower acceptance of problem behavior, and greater sense of autonomy from marijuana use post-intervention than participants in the comparison condition (n=128, 66.4% male). Conversely, post-intervention group differences were not observed for peer refusal skills or autonomy from alcohol use. A description of the Campus Corps program design and supplemental preliminary findings contribute to the growing knowledge base of youth mentoring program designs and outcomes.

Media resistance skills and drug skill refusal techniques: What is their relationship with alcohol use among inner-city adolescents?

Past research related to alcohol advertising examined whether underage adolescents were targets of the alcohol industry and what impact such advertising had on adolescent drinking. The purpose of this study was to longitudinally examine the impact of media resistance skills on subsequent drinking among adolescents residing in inner-city regions of New York City. The study also tested whether drug skill refusal techniques (knowing how to say no to alcohol and other drugs) mediated the relationship between media resistance skills and adolescent drinking. A panel sample of baseline, one-year and two-year follow-ups (N=1318) from the control group of a longitudinal drug abuse prevention trial participated. A series of structural equations models showed that media resistance skills directly negatively predicted alcohol use 2 years later and that drug skill refusal techniques mediated this effect. Baseline media resistance skills were associated with one-year drug skill refusal techniques, which in turn negatively predicted two-year alcohol use. These findings provided empirical support for including media resistance skills and drug skill refusal techniques in alcohol prevention programs.

Racial/ethnic differences in the protective effects of self-management skills on adolescent substance use

A variety of cognitive and behavioral self-management skills have been posited as protective in terms of adolescent substance use. This study examined whether these skills measured in the 7th grade served a protective function in 9th grade substance use across ethnically diverse samples of adolescents. Participants consisted of Black (n = 461) and Hispanic (n = 320) urban youth and White suburban youth (n = 757). Structural equation modeling indicated that a second order Self-Management Skills latent factor consisting of first order latent factors of Decision-Making, Self-Regulation, and Self-Reinforcement skills was protective for adolescent substance use across racial/ethnic subgroups. However, Self-Management Skills were more strongly protective for suburban White youth and less protective for urban minority youth. These findings are consistent with previous research showing that predictive power of risk and protective factors derived from psychosocial theories varies widely across racial/ethnic subgroups of youth and is weaker among racial/ethnic minority youth compared to White youth. An important next step is to broaden the focus of etiology research from individual-level determinants to studying adolescent substance use behavior in the context of the cultural background and primary social settings of young people, such as family, school, and community environments.

Do Competence Skills Moderate the Impact of Social Influences to Drink and Perceived Social Benefits of Drinking on Alcohol Use Among Inner-City Adolescents?

Only a few studies have found competence skills to be a protective factor against adolescent alcohol use; others did not find a direct effect on alcohol. A possible reason for this is that competence skills may moderate the effects of risk factors for alcohol use and that aspect has not been examined often or in a longitudinal design. This study tested whether several competence skills served either as direct protective factors against alcohol use or moderators of the impact of social risk factors on alcohol use. Participants (N = 1318) completed questionnaires that included measures of decision-making skills, refusal skill techniques, resisting media influences, friends' drinking and perceived social benefits of drinking, as well as current drinking amount and future drinking at baseline, one-year follow-up and two-year follow-up. Data analyses were conducted using multi-level mixed effects generalized linear models with random intercept. All the competence skills and the risk factors predicted current and future drinking. Several significant interactions were found between (1) perceived social benefits of drinking and decision-making skills, (2) perceived social benefits of drinking and refusal skill techniques and (3) friends' drinking and refusal skill techniques. Competence skills served as protective factors, as well as moderators. One possible reason that competence enhancement approaches to alcohol prevention are effective may be due to the inclusion of the competence skills component.

Common predictors of cigarette smoking, alcohol use, aggression, and delinquency among inner-city minority youth

The present study examined the prevalence rates and common predictors of substance use, aggression, and delinquency among inner-city minority youth entering middle school. A survey was administered to sixth grade students (N=5442) from 42 New York City schools. Aggressive behaviors were reported most frequently, followed by delinquent behaviors, alcohol use, and cigarette smoking. Across all behavioral outcomes, social and environmental influences explained the largest proportion of variance, followed by individual characteristics and skills, bonding to conventional institutions, and demographic variables. For the majority of predictor variables, there was substantial overlap in patterns of prediction across outcomes. These findings indicate that several factors that correspond to the predominant psychosocial theories of adolescent development explain variation across different problem behavior outcomes among inner-city minority youth.

Responding to victimized Alaska Native women in treatment for substance use

High rates of physical and sexual abuse have been found among Alaska Native women entering a residential treatment program in Fairbanks, Alaska. Little information, however, has been available that describes the nature of such abuse and its relationship to treatment outcome. This article describes the extent of such abuse and reviews factors involved in its onset. The implications of the findings are discussed with an emphasis on how they can be applied to enhance treatment outcome.

Ethnic and gender differences in psychosocial risk, protection, and adolescent alcohol use

Theoretical models suggest that many diverse psychosocial factors contribute to the etiology of substance use among youth. It has been suggested that substance use is a function of the total number of etiologic factors, rather than a specific type or set of factors. This study examined whether cumulative psychosocial risk and protection measured in the 7th grade predicted alcohol use in the 9th grade across ethnically diverse samples of adolescents. Participants consisted of black (n = 775) and Hispanic (n = 467) inner-city youth and white suburban youth (n = 708). Prevalence rates for alcohol use and risk/protection varied more widely based on ethnic group compared to gender. Black youth reported the fewest risk factors and lowest levels of alcohol use, white youth reported the most risk factors and highest levels of alcohol use, and Hispanic youth reported the fewest protective factors and intermediate levels of alcohol use. Despite these differences, structural equation modeling indicated that a latent factor consisting of cumulative risk, protection, and their interaction significantly predicted later alcohol use for the combined sample as well as for each ethnic/ gender subgroup. However, the proportion of variance explained in alcohol use varied across subgroups, and moderator analyses indicated that protection significantly buffered the effects of risk differentially across subgroups. The strongest protective effects were observed among black inner-city youth. Findings suggest that prevention approaches should focus on enhancing protection in addition to reducing risk, particularly among youth with lower levels of psychosocial protection.

Marijuana use among minority youths living in public housing developments

Youths residing in public housing developments appear to be at markedly heightened risk for drug use because of their constant exposure to violence, poverty, and drug-related activity. The purpose of this study was to develop and test a model of marijuana etiology with adolescents (N = 624) residing in public housing. African-American and Hispanic seventh graders completed questionnaires about their marijuana use, social influences to smoke marijuana, and sociodemographic and psychosocial characteristics. Results indicated that social influences, such as friends' marijuana use and perceived ease of availability of marijuana, significantly predicted both occasional and future use of marijuana. Individual characteristics such as antimarijuana attitudes and drug refusal skills also predicted marijuana use. The findings imply that effective prevention approaches that target urban youths residing in public housing developments should provide them with an awareness of social influences to use marijuana, correct misperceptions about the prevalence of marijuana smoking, and train adolescents in relevant psychosocial skills.

Psychosocial predictors of cigarette smoking among adolescents living in public housing developments

BACKGROUND

Adolescents residing in low-income public housing developments in inner-city regions may be particularly vulnerable to a variety of risk factors associated with cigarette smoking.

OBJECTIVE

To elucidate the aetiology of cigarette smoking among adolescents living in public housing developments.

DESIGN, SETTING, AND SUBJECTS

We examined predictors of smoking from four domains: background characteristics, social influences, behavioural control, and psychosocial characteristics using a sample of seventh graders (mean age 12.9 years) who reside in public housing developments in New York City (n = 624). The addresses of participants in a larger investigation of the aetiology and prevention of smoking were checked to determine if they lived in one of 335 public housing developments in New York City. All participants living in public housing developments were included in the current study.

MAIN OUTCOME MEASURES

African-American and Hispanic students completed questionnaires about their cigarette use, social pressures to smoke, smoking attitudes, smoking knowledge, and smoking resistance skills. Students also provided information on demographic and behavioural control (such as church and school attendance).

RESULTS

Logistic regression analyses indicated that social influences from friends and family members predicted smoking. Psychosocial characteristics such as advertising resistance skills, anti-smoking attitudes, and refusal skills lowered the odds of smoking.

CONCLUSIONS

These findings suggest that smoking prevention approaches targeted at these young people should increase their awareness of social pressures to smoke, correct misperceptions about the prevalence of smoking among friends, and teach relevant psychosocial skills.